ARTICLE - LIFE AND DEATH IN HAITI

AMID TRAGEDY OF CHOLERA, LITTLE MIRACLES
(Miami Herald) - By Trenton Daniel

Pregnancy amid cholera equals heartbreak. But some babies beat the odds.

PORT-AU-PRINCE -- As the nurse dodged assistants, her desperately ill patients rolled on their cots in pain. A few called for Jesus.

The young women were days – sometimes only hours – away from giving birth, but most would not be mothers. All were stricken with cholera, a debilitating waterborne disease that makes pregnancy loss the norm. But there is the rare birth when a woman beats the odds and becomes a mother.

This past Tuesday, it was 24-year-old Barbara St. Jean. As she recovered from the birth and her bout with cholera, she rocked her baby in her arms.

The 2-month-old cholera epidemic has already become such a part of daily life in Haiti that it has created a new specialty in the medical community: midwives for cholera patients. When a cholera-stricken mother’s baby is born alive, the child is separated from her and immediately cleansed with chlorine. The baby gets special milk while the mother continues three days of rehydration treatments. With health officials saying it could be years before cholera runs its course in Haiti, such complicated births are just one more thing that medical personnel in this earthquake-ravaged country must contend with.

“We started with one patient. A week later, we had 10 patients,’’ said Felipe Rojas Lopez, 27, a midwife from Chile who works for the medical relief group Doctors Without Borders. “We are a little overwhelmed with patients.’’

DEADLY TOLL
So far, Haiti’s cholera outbreak has killed more than 2,400 people and another 96,000-plus have been hospitalized with the disease. But the number of cases could be much higher because many in the country’s most remote corners fail to reach clinics for treatment.

Global health experts say as many as 80 percent of the people who’ve contracted the illness don’t show symptoms such as watery diarrhea and vomiting. Health experts say cholera will continue to spread because of poor sanitation and estimate the disease could potentially affect more than 600,000 people in Haiti. Perhaps just as worrisome, the bacteria that cause cholera is expected to stay in the country for several years.

“It’s something Haiti will have to deal with,’’ said Christian Lindmeier, a spokesman for the World Health Organization/Pan American Health Organization. “The country will have to learn to live with it for awhile.’’

Cholera was found in Haiti’s Artibonite region in October and some suspect Nepalese troops with the United Nations peacekeeping mission may have brought the disease.

Epidemiologists say the strain found in Haiti matches one in South Asia. After weeks of anti-UN protests in November, UN Secretary-General Ban Ki-moon called last week for an independent investigation to look into whether the Nepalese peacekeepers are indeed responsible for bringing cholera to Haiti.

Before October, cholera wasn’t something people talked about. They were busy trying to recover from the devastating Jan. 12 earthquake. After October, it’s something everybody talks about.

Cholera – kolera in Haitian Creole – has entered the popular lexicon. It’s become synonymous for something to be abolished, eliminated, or jettisoned. In recent weeks, angry anti-government protesters equated outgoing President Réne Préval with the disease.

The heightened awareness of cholera is everywhere.

The U.S. State Department noted the outbreak in a newly issued travel advisory, warning against unnecessary travel to Haiti.

The Isaie Jeanty hospital near downtown Port-au-Prince has seen between 50 to 60 expectant mothers since the first week of November, said Lopez of Doctors Without Borders. It’s believed to be one of Haiti’s few maternity wards for cholera-infected mothers.

A professor at Columbia University’s Mailman School of Public Health and School of Nursing, Richard Garfield, estimates that Haiti may have had between 2,000 and 3,000 pregnant women with cholera.

ONE IN TEN
But fewer than 10 percent of the expectant mothers at Isaie Jeanty actually give birth, Lopez said. The fetus often suffocates because the mother is too weak to push the baby out of the birth canal.

“It’s not very encouraging for us as a team,’’ Lopez said.

The pregnant women arrive from neighborhoods and cities such as Carrefour, Cite Soleil, and Fontamara. One woman whose baby died in the womb this past week came from Cabaret, a town six miles north of Port-au-Prince.

She had passed on her local hospital.

“It was too expensive,’’ said Daphinee Saloman, a 16-year-old who was lying on a cot in a tent where women grieve for their offspring who died in childbirth – and are reunited with babies born alive.

Since there are so few successful births among women stricken with cholera, little stories of happiness are especially prized.

“These are the ones we have to celebrate,’’ said Tara Newell, a project coordinator for Doctors Without Borders. In the hospital’s neo-natal unit last week the son of 20-year-old Beatrice Pris napped.

“He’s small but not unhealthily small,’’ said Newell. “He is going to survive. He’s fine. We’re giving him a little oxygen.’’ Pris rested in a separate part of the hospital and received treatment for cholera. Later in the week, he joined the other babies in a row of beds. Above his head, a nurse had placed a “Joyeux Noel’’ sticker.

Barbara St. Jean was also among the lucky few. On a Wednesday afternoon, she was reunited with her yet-to-be-named baby boy and held him for the first time.